- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.82 / $3,622.23 / $13,203.20
| Facility | | $2,660.82 | $3,622.23 | $13,203.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.13 / $2,987.15 / $3,263.27
| Professional | | $1,506.13 | $2,987.15 | $3,263.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,718.06 / $4,902.18 / $7,724.42
| Facility | | $2,718.06 | $4,902.18 | $7,724.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,510.21 / $2,510.21
| Facility | | $2,510.21 | $2,510.21 | $2,510.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,631.64 / $2,021.60 / $19,059.41
| Facility | | $1,631.64 | $2,021.60 | $19,059.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,506.13 / $3,419.42
| Professional | | $1,054.29 | $1,506.13 | $3,419.42 |